"Survivor MD: Hearts & Minds"

NARRATOR: This time on NOVA, a unique behind-the-scenes look
at what it really takes to become your doctor.

ELLIOTT BENNETT-GUERRERO: How did she...

DAVID FRIEDMAN: No, she was way over this way.

JAY BONNAR: It feels like such a costume right now.

STUDENT: Here's the ligament right here.

INSTRUCTOR: I just want to show you that this is a perfectly normal
brain.

DAVID FRIEDMAN: Oh man, this needle could kill a horse.

JANE LIEBSCHUTZ: David, will you shut up!

NARRATOR: The story begins in September 1987, as a new class
enters Harvard Medical School. Almost immediately, the students embark on a
journey into our bodies and minds, a process that will change them from
ordinary mortals into fully-initiated members of the medical tribe.

JAY BONNAR: The first thing I want to do is to take your vital
signs.

JANE LIEBSCHUTZ: Let me see under your tongue.

NARRATOR: For fourteen years our cameras have been there. From
the early days of medical school through the sleepless nights of internship,
NOVA has followed seven men and women through their grueling medical
apprenticeships.

DAVID FRIEDMAN: We all did well in school, and to come in and be
given a test where you know nothing, it's really hard.

JAY BONNAR: Last year I felt I was incredibly ignorant and I couldn't
possibly be in the hospital as such an ignorant person. This year, I realize
I'm still pretty ignorant, but I've gotten used to it.

CHERYL DORSEY: And as soon as he said, "I'm having heart problems,"
my heart just sank, because these tend to be the most difficult cases. And all
these questions that I know I should've asked, I'm sure I didn't.

JANE LIEBSCHUTZ: I know right now is not the time to make a decision
whether the price is too high to pay to become a doctor, which is what I want
to do. But I sometimes wonder whether it's all worth it.

ELLIOTT BENNETT-GUERRERO: It's like a kid going into the candy store.
It's overwhelming. There's so much there. And there's just so much you'd like
to do.

TOM TARTER: "This ain't no party, this ain't no disco, this
ain't no fooling around." This is, like, the real deal. People are really
sick.

LUANDA GRAZETTE: What if there's a split-second decision that I have
to make, and I don't know what to do?

NARRATOR: In this hour, the experiences of three of these
doctors.

First, Luanda Grazette, cardiologist at Mass General Hospital
in Boston. Her specialty: people who need heart transplants.

LUANDA GRAZETTE: She's actually got pretty reasonable coaptation of her
mitral valve. I thought she was going to have a very wide anulus.

I'm really just getting out of training. My compatriots who went to law
school or business school or whatever else, were full-fledged citizens
ten years ago.

NARRATOR: Elliott Bennett-Guerrero is an
anesthesiologist at New York's Columbia Presbyterian Hospital. At only 35, he's
become Director of Cardiac Anesthesiology.

ELLIOTT BENNETT-GUERRERO: I work with the surgeons day in and day
out.

LADY: How many of these surgeries have you done?

ELLIOTT BENNETT-GUERRERO: Excuse me?

LADY: How many have you done?

ELLIOTT BENNETT-GUERRERO: Too many too count.

LADY: She's a nurse.

ELLIOTT BENNETT-GUERRERO: Here's my card.

My goal of wanting to fix people, actually see the results right
there in front of me within hours or within days is something I've been
able to achieve going into cardiac surgery and anesthesia.

NARRATOR: Jay Bonnar is a psychiatrist. He's currently in
training to become a psychoanalyst and is in analysis himself. This process has
made him very reluctant to be filmed at this point in his life.

JAY BONNAR: Actually, it's embarrassing to go back and watch the old
tape, as I recently did. I'm just struck by how full of myself I seemed. I
guess that goes along with youth, but it's embarrassing. One of the changes
that's happening as a result of my psychoanalysis is that I no longer want to
be broadcast to the nation. I was a young and vain boy 13 years ago. I'm still
vain, but less young.

Major funding for NOVA is provided by the Park Foundation, dedicated to
education and quality television.

Scientific achievement is fueled by the simple desire to make things clear.
Sprint PCS is proud to support NOVA.

This program is funded in part by the Northwestern Mutual Foundation. Some
people already know Northwestern Mutual can help plan for your children's
education. Are you there yet? Northwestern Mutual Financial Network.

And by the Corporation for Public Broadcasting, and by contributions to your
PBS station from viewers like you. Thank you.

JAY BONNAR: Actually the jacket feels kind of weird, I was
commenting. It feels like such a costume right now. I'm trying to get used to
it. Just before I met my first patient I was all anxious. I don't know a heck
of a lot now, clinically, about what to do when.

DOCTOR ONE: I want to introduce you. This is Jay Bonnar.

PATIENT: I don't remember good, dear, but hi.

DOCTOR ONE: Well, Jay's the one you're mostly going to be talking
to.

JAY BONNAR: First I'd just like to talk about your cough, and what's
brought you into the hospital. And then after we talk for awhile I'd like to do
an exam of the back of your chest, to listen to...

The patient has been treating you more or less like a doctor, but
you're going to fumble. You're going to be a little hesitant. And you're sort
of afraid that the patient will look at you and say, "I don't want this
person near me. Get this away from me."

If you could take off your top and put on the johnny that you have, open in
the back. You can leave on your skirt and the rest. And we'll all move over to
this half of the room.

PATIENT: You mean I got to get nude?

DOCTOR ONE: No, we're going to close the curtains.

PATIENT: See this body of mine?

STUDENT: You did a great job, Jay.

JAY BONNAR: I guess the first thing I want to do is take your vital
signs, before I forget that. I'm still a little new at this so it may take me a
moment to find...if you'll bear with me.

Touching patients is not easy, particularly at first. I remember
that that was one of the hardest things I did with the first patient. You are
worried that they're going to figure out how ignorant you
are.

The other thing I wanted to know is if you have any questions. If there's
anything you'd like to know from me?

PATIENT: No, darling. I know just one day you're going tobe a great doctor and I'll still be around to see you.

JAY BONNAR: I really enjoy seeing patients. I wish I could see them
every week. It reminds me of what I'm doing in medical school.

INSTRUCTOR ONE: So the knee goes extension, flexion, extension.

INSTRUCTOR TWO: This is called the peri-umbilical area.

JAY BONNAR: Quite frankly, it's hard. It really is hard to be in
medical school. It goes at such a pace. It's so all encompassing of your life.
Emotionally, it's a lot of work to keep up that kind of high energy level.
Although I enjoy the thrill of pure science, it's not my principal reason for
being there.

When I first got in, I kept wondering if it was a mistake. Somebody's going
to pull me aside and go, "Didn't you get that next letter that said
we're sorry, but the first one was a mistake?" It was kind of strange. Because
even though when I interviewed here and I toured the place I really felt at
home, I still, I've never pictured myself in the environment. And I still, when
I walk across the quad sometimes, it just kind of ...it hits me. "God, I'm at
Harvard."

ELLIOTT BENNETT-GUERRERO: This afternoon, in the course where we
learn how to examine patients, I'm going to do something which I'm a
little bit anxious about.

INSTRUCTOR: You have to think about this a little differently if
you're woman and if you're a man, in terms of how you touch. You don't want to
touch lightly and it feels maybe caressing, but, kind of, firmly. Just say, "If
you relax these muscles and can let your legs go a little bit it may be more
comfortable for you during the exam."

ELLIOTT BENNETT-GUERRERO: I don't feel I can go in any deeper.

INSTRUCTOR: No, you can't. This model has a very short vagina. So you're
absolutely right.

ELLIOTT BENNETT-GUERRERO: Do you take a peek until you're going
in?

INSTRUCTOR: Imagine this. Make a circle for me. That's the vagina.
Elliott, let me show you. You go in like this and then you turn, and then you
slowly open it as you're going. Do you see that?

ELLIOTT BENNETT-GUERRERO: So you can kind of look as you're going
in?

INSTRUCTOR: Absolutely. With a light over your shoulder.

ELLIOTT BENNETT-GUERRERO: You're not going in blind, then opening it
up?

INSTRUCTOR: Of course not. You're going in very gradually. You see
that?

ELLIOTT BENNETT-GUERRERO: I feel uncomfortable doing this and it's
just a plastic model. If we had to do this to begin with on a real
patient, I don't know if I'd be able to function.

INSTRUCTOR: Unscrew the screw. Other way.

ELLIOTT BENNETT-GUERRERO: Trying.

INSTRUCTOR: Are you trying to release it? Goodness. Secret—never do
the screw that hard. Then you're really in a bind. My goodness. It would never
get out.

EXAMINER: You have 30 minutes in which to finish this test book. Please
recall that only...

ELLIOTT BENNETT-GUERRERO: The national board is a three-part exam,
which we're required to pass in order to become licensed physicians in this
country. It's a two-day exam with hundreds of multiple choice questions
covering the material we've learned in the first two years of medical
school.

LUANDA GRAZETTE: I guess it's sort of a contradiction that we
spent the first two years sort of learning concepts and how to study and
thinking in very broad terms, and then you have to take this test that's really
a lot like Trivial Pursuit.®

DAVID FRIEDMAN: I didn't know the difference between those things. I
forgot it.

ELLIOTT BENNETT-GUERRERO: I know. There's niacin and actin, and I don't
really know how they interact.

JAY BONNAR: It's wonderful. I'm thrilled to be finished, but quite
tired. I can look forward now with expectation to my wedding, which is
only in a week. You're all invited.

KATHERINE: Jay has been quite a bit different than he usually is.
He's very tense. Wouldn't you say?

JAY BONNAR: It's already been an issue that I'm in medical school
because it creates a certain amount of stress. I think we both hear awful
things about how little time residents have and things like that.

KATHERINE: It's almost fatalistic. In fact people say, "Oh, you're
going to marry a doctor." They sort of look at me knowingly. It's hard to
anticipate exactly what this is going to mean. I think we're going to have to
be in a position where we can work on these things because otherwise I don't
think it's going to work. I should be more positive.

JAY BONNAR: No, you should be more specific.

MINISTER: I now joyfully pronounce them husband and wife. Go in
peace.

JAY BONNAR: Now that I'm married I think the next major event in my
life is going be going into the hospitals. After two years of going to
classes, I'm getting really tired of it and I'm ready to go in and start
working with patients first-hand.

Miss Brown, hi.How are you today?

Miss Brown is a patient who was in the hospital, and unfortunately, while
there, fell and broke her hand. I was asked to see her and do a neurologic
examination to see whether she might be unsteady.

MISS BROWN: And I was so happy to get that bible you give me, and I've
been praying for you. And I know you've been praying for me 'cause you said you
would. And I believe you are a Christian and I know I am. And I pray that God
will bless you all. I love you all, and I always say, "Lord, help us to help
each other Lord. Each other's cross to bear. Let each a friendly aid afford and
feel one another's care." God bless you.

JAY BONNAR: I went to see Miss Brown to look into why she fell and
talk about some of her recent memory problems.

I think this interview was difficult because Miss Brown was not comfortable
letting us see those areas where she knew things weren't right. But I, on the
other hand, needed to know precisely those things, because I knew thatI'd soon be presenting them to my attending, Dr. Poser.

Deviation to the tongue to the right. I wasn't sure that that was a
significant finding or whether that just happened to be
accidental.

DR. POSER: Now wait a second. If she has a real deviation of the tongue,
what does that mean?

JAY BONNAR: It means there's something wrong with her cranial
nerve.

DR. POSER: On what side?

JAY BONNAR: On the right side. The twelfth cranial nerve.

DR. POSER: I know, but the tongue deviates to the right, let's say.
Where's the lesion? On which side?

JAY BONNAR: Left side of the brain.

DR. POSER: Left side of who?

JAY BONNAR: Left side of the brain.

DR. POSER: Of the brain.

JAY BONNAR: If it's cortical. But then it could also be the
right.

DR. POSER: Did you ever see a deviation of the tongue from a cortical
lesion?

JAY BONNAR: I've never seen a deviation of the tongue from a cortical
lesion.

DR. POSER: Why's that?

JAY BONNAR: Because I've only been in neurology about a week.

DR. POSER: Beth, did you ever see a deviation of the tongue from a
cortical lesion?

BETH: No.

DR. POSER: Why not?

BETH: The brain stem, many of the nuclei, including the twelfth cranial
nerve, are bilaterally innervated. Therefore, you'd have to have bilateral
cortical strokes to produce a deviation, in which case it wouldn't go to either
side.

JAY BONNAR: It feels terrible when you have doctors you're looking up
to for guidance and teaching making you feel humiliated. A lot of the
experience of being in medicine is feeling humiliated. That's compounded by the
fact that you change hospitals every month or nearly every month. You don't
know where you are, you don't know any of the people, you don't know the
procedures. So you feel ungrounded as it is. And to have people accosting you
with "what's this minutiae or what's that minutiae?" You feel
bad.

I believe it occurs in women more often.

DR. POSER: In what kind of women does it occur?

JAY BONNAR: Older women?

DR. POSER: What kind of women, Beth?

BETH: Women who've had a lot of kids.

JAY BONNAR: You lose touch with your own strength in a way if you
keep staying in that environment and keep questioning yourself for long
enough. You begin to think, "I'm the one that's ignorant here. I'm the one
that's faulty. Everyone else around me is wise and efficient and powerful and
does a great job, and here I am, just a lowly little speck. If only I can be
like them."

ELLIOTT BENNETT-GUERRERO: This week I work at nights, and then, at
least I try to, sleep during the days. I start in the hospital around
seven or eight at night, and I go 'til about 10 the next morning. The hardest
thing about it is your whole sleeping schedule gets all screwed up.

Well, right now we're going to be giving a Cesarean section. It should
take about...less than an hour. And what's really nice is that as you
get a little bit more experience and as the attendings and theresidents get to know you, you get to do more and more at each
delivery. I'm thinking a lot about becoming an obstetrician-gynecologist.
Because what I think is nice about it is you get to operate and do procedures.
It's a happy specialty. With most of the women who come in here, you're almost
assured that within 24 hours they'll have a baby.

TEAM: It's a boy.

Oh my goodness.

Eight-and-a-half-pound boy.

He's cute.

ELLIOTT BENNETT-GUERRERO: It's really nice when...at the end of the
delivery and she looks...the baby's already out...it's nice to see how happy
she is. I've had a couple of women kiss me after their baby is delivered. It
makes your day when that happens. One couple gave me a box of chocolates. It
really made me feel special. It made me feel very happy that I'd shared
this important moment with them.

I was very disappointed when I saw my OB/GYN course evaluation grade. Not
only did I think I worked hard during the rotation, I really enjoyed it. And
for several months I was actually considering OB/GYN as a career choice. And I
think for that reason it particularly hurt me when I didn't do as well as I
thought I was going to do. I felt that a lot of the people weren't honest with
me. And if they felt I should've been working harder or they didn't like me,
nobody ever told me. And for that reason I was particularly
disappointed.

LUANDA GRAZETTE: Right now I'm doing Cardiology, at New England
Deaconess Hospital. I'm really enjoying it a lot.

Mr. Burke? Hi. My name is Luanda Grazette. I'm one of the students with
Cardiology. We've been asked to come in and take a look at you because we
understand that you have a history of some heart disease in the
past.

Cardiology is a study of the heart and the blood vessels associated with
it, which means it's basically hydraulics. You've got a pump, which is
the heart, and then you've got all these pipes of varying sizes attached
to it. You want to optimize flow through those pipes so that all the
organs get enough blood.

Would you say you have chest pain once a month or once a year?

MR. BURKE: I've had them for the last three weeks. I've had more than
I've had in the last two years, see, but not severe.

LUANDA GRAZETTE: One of the things that I really like
about cardiology is that most of the time you are dealing with an older patient
population. I like working with older people. I like to chat with them. I enjoy
them a lot. I think they enjoy me. I was raised by my grandmother so I guess
I've always had interactions with older folk, and I see that being part of my
career.

When did you lose your wife?

MR. BURKE: A year ago.

LUANDA GRAZETTE: Do you have any family here? Any children?

MR. BURKE: I have some children, yeah.

LUANDA GRAZETTE: Well I'm sure they have a stake in whether or not
you're...

MR. BURKE: My baby's 38 years old. I don't worry about it. I've been
around for a while. I'm useless for anything.

LUANDA GRAZETTE: I'm sure you're not useless. I'm sure that if
you ask any of them they would tell you that they need you around for
counseling and advice and all the things that you probably don't think are
important, that are probably quite important to them.

MR. BURKE: ...the only way I can get up at the moment.

LUANDA GRAZETTE: That's good. That's good.

You told me a couple of times that you were afraid that you were going
to have one of those attacks. How do you know when they're coming on? How can
you tell? Do you just know from experience what brings it on?

When we were out in the hall walking, it seems as if he was getting
a little dizzy. And I was happy that there were a lot of people around to look
out for things like that. But that's actually not that unusual, people getting
up after being in bed for a long time will have the same sort of thing happen
the first time they get out of bed.

ELLIOTT BENNETT-GUERRERO: Okay, I'm just going to put this little sticky
thing on your finger. It doesn't hurt. This is just to measure the oxygen in
your blood. I promise you it won't hurt you.

MRS. KIDDER: I trust you completely.

ANESTHESIOLOGIST: Now we'll be putting in a neck line, which
requires certain positioning, so we will lower your head and put your head
down.

ANESTHESIOLOGIST: Now we will use a finer needle, which is a
32-gauge needle. Now with this hand, hold the syringe and rest your hand
against patient's face. Now, insert in the same direction at this point...take
the small needle out.

ELLIOTT BENNETT-GUERRERO: I felt very comfortable helping to put in
the central line because I was being supervised by someone who was very, very
skilled—very competent in the placement of these lines.

ANESTHESIOLOGIST: In more and out.

ELLIOTT BENNETT-GUERRERO: Although I was the one actuallydoing the actual maneuvers, I knew that he was really the one behind
me pushing them in.

ELLIOTT BENNETT-GUERRERO: Obviously it bothers me when a patient
feels discomfort, especially when I'm doing something to them that's
hurting them. But I guess what makes me get through this feeling I have is that
I try to think, "Well maybe I'm giving them less discomfort than somebody else
would be, and also maybe I can do a good job at trying to comfort
them."

The worst part's over. There shouldn't be any more pain, any more
discomfort.

For the past year, I've been taking all these specialties, like radiology,
pediatrics, medicine and surgery. Now I'm taking anesthesiology and I really
think it's the field for me. Not only do I find it interesting, it pays well
and it's got a good lifestyle. Although you get to the hospital very early, you
tend to leave earlier. And now that I'm going to begetting married in a
few months I really think it's important that I choose a specialty where I'm
going to be able to spend time with my family.

MELISSA: I had an accident with my toe and I went to the Mass.
General Hospital Emergency Room. And Elliott was doing emergency room rotations
at the time, and he actually worked on my toe and put the sutures in my toe and
ended up giving me his number in case I had any problems afterwards.

ELLIOTT BENNETT-GUERRERO: And we went on our first date two months
later.

MELISSA: I actually called him up to thank him for all the work he
did on my toe, and he asked me out and we started dating right after
that.

ELLIOTT BENNETT-GUERRERO: And it will be a year November
29th.

ANNOUNCER: Jay H. Bonnar.

JAY BONNAR: At last!

ANNOUNCER: Luanda Pampata Grazetta.

ANNOUNCER: Elliott Bennett-Guerrero.

ELLIOTT BENNETT-GUERRERO: This thing's in Latin. You can't even
understand a word of it.

LUANDA GRAZETTE: I'm going to miss this. I'm going to miss being so much
a part of this Harvard Medical student experience.

JAY BONNAR: It's going to be wonderful to finally be Jay Bonnar, M.D.,
instead of Jay Bonnar, the medical student.

RESIDENT: Good to see you. How you doing? Excited? Good. We'll run
rounds today, and we'll use the rest of the morning to catch up.

LUANDA GRAZETTE: When you start out, you are a doctor. You've been to
medical school. Learning to be a doctor is an apprenticeship. That's why people
work for hospitals for these ungodly numbers of hours for really minimal
salaries. It's because you're serving in an apprenticeship. You will give them
a large number of man-hours to take care of their patients at low cost, and in
return they will teach you how to be a doctor.

How long have you been on the iron?

PATIENT: For the last month or so.

LUANDA GRAZETTE: Have you had any fevers?

PATIENT: No.

LUANDA GRAZETTE: Any chills?

PATIENT: This morning I had a little chill.

LUANDA GRAZETTE: It all seems really cumbersome right now. All these
patients, and they all have multiple problems. And they're going for tests and
results are coming back from tests and you are making treatment decisions based
on tests. And it's sort of...keeping it all straight—who got what, when and
how, what they need next—is kind of...can be kind of mind-boggling.
It's a lot of information to keep track of.

HOSPITAL STAFF: Excuse me, Luanda. There's a call for you on line 10.

LUANDA GRAZETTE: I think everybody has that feeling, "Oh, god. What
if there's a split second decision that I have to make and I don't know what to
do?"

DOCTOR ONE: She's a 77-year-old lady with a history of many M.I.s, who's
admitted with a chief complaint of abdominal pain. She had deep ST depressions
in the anterior leads. Got a KUB. Her PT and OT are up a little bit, and with
the TNG, her blood pressure dropped a little bit, but the abdominal pain was
unchanged.

LUANDA GRAZETTE: Hopefully in a week, I'll sort of have my
system together, and that's what I'm really working on tonight. Trying
to figure out what's going to be a good system for me, that will keep me
from going back to the chart three times to see if I checked X and did Y and so
forth.

PATIENT: It started out in the back of my legs, this was in September. I
had the operation. Now the front of my leg from here down is numb. And every
time I take a shower my whole leg gets numb.

JAY BONNAR: So when you shower, you take your clothes off?

PATIENT: Well I don't take a shower with my clothes on. Of course I
do.

JAY BONNAR: He says that when he takes a shower it becomes
numb up to his waist, the whole leg. Apparently when he says numb, he means no
feeling, to the best of my ability to say.

I'd like to ask you what exactly it is that you feel, and then come to
a...

PATIENT: My leg is numb. What else can I say to you?

JAY BONNAR: That's fine. It may interest you to know that different
people mean different things by that phrase.

PATIENT: My leg from here to the tip of my toe is numb.

JAY BONNAR: I tried to explain that people have other meanings that
sometimes get used with that word, but he was sort of resistant to
that.

I appreciate that this is something that has you very concerned, and you
appear to be a little irritated at some of my questions.

PATIENT: I'm not irritated. I'm just tired of not getting any answers.
That's what I'm irritated about.

JAY BONNAR: I still don't understand exactly what's happening.

PATIENT: Well, if you've got my file. All right. You're supposed to have
all of this stuff when I get down here so you'll know what the hell
you're talking about. Do I have to explain the operation to you?

JAY BONNAR: No. I'd like to ask you what exactly it is that you
feel and then come to an understanding.

PATIENT: My leg is numb, what else can I say to you?

JAY BONNAR: Had a bit of difficulty asking him specific questions
about the nature of the sensory deficit. He got quite irritated with my
questions and felt that I should know the answers already and why wasn't
I telling him what was going on?

PATIENT: I want to know what the hell is going on with my foot.

JAY BONNAR: We'll do everything within our power to come to that
decision today.

PATIENT: I certainly hope so. I certainly hope so.

JAY BONNAR: I tried to reassure him a little bit. I think he got more
comfortable once I started examining him. He felt I was actually doing
something. I think that was what impressed him. Doing something.

ELLIOTT BENNETT-GUERRERO: Right now I'm at the Framingham Union
Hospital which is outside of Boston.

Hi. How are you? I have a list of the medicines you've been taking. Have you
been taking...

PATIENT: It's quite a list.

ELLIOTT BENNETT-GUERRERO: The Cimetadine, Lopressor, Micronase,
Procardia, Lasix? Every day you take that in the morning?

PATIENT: Yes, in the morning.

ELLIOTT BENNETT-GUERRERO: An aspirin a day, and the Prozac and the
Captopril and the Isordil? All of that?

PATIENT: All that.

ELLIOTT BENNETT-GUERRERO: A lot to keep track of.

PATIENT: Take them all at once, too.

ELLIOTT BENNETT-GUERRERO: What do you need? You practically need like a
computer, right, to remind you when to take your pills?

PATIENT: I often wonder if they know in which direction to go.

ELLIOTT BENNETT-GUERRERO: You think they're giving you pills that send
you off in different directions?

PATIENT: I wish they'd send me off. Cloud nine.

ELLIOTT BENNETT-GUERRERO: You're not walking for me. Does your neck feel
stiff at all? Does that hurt at all?

Well, right now I'm six months into my internship and I'd say I'm
gradually just getting more and more tired. I think in part because I
never really get a free weekend the whole year. I get three one-week blocks of
vacation, but other than that I never have a whole weekend off.

MELISSA: Being married your first year is difficult enough in itself
without having your husband work 80 and 90 hours a week, and then come home and
be exhausted. It's very sad. It's very hard. I'm very lonely.

ELLIOTT BENNETT-GUERRERO: Half the year, I'm on call every third
night. And I think what she's realizing is that not only does she not see me
when I'm on call the one out of every three nights, but the other two nights,
especially the night when I'm post-call, sometimes I go home and I'm
just exhausted.

JAY BONNAR: Right now, it's January and I'm in medicine, ward
medicine, which means that I take care of patients admitted to the
hospital with basically any problem that doesn't require them being on a
surgical service. It is the rotation, which is, at this hospital, one of
the most difficult ones in terms of the workload.

Can you call a nurse? She's starting to move.

I've gotten to a point, where...it's not that I don't care about patients,
but the fact that I care about patients becomes less important than the fact
that I am absolutely strung out and absolutely can no longer think any more. I
forget simple basic things. People will remind me, "You didn't do this thing on
this patient." I'll be like, "Oh, Jesus, I can't believe I forgot that. And
that happens a lot. I came into medical training, I think, one of the more
sensitive people in the field. I'm going into psychiatry. My whole emphasis is
on the emotional and the understanding—the mental aspects of medicine. And
yet, for all of that interest on my part, I cannot help but become this person
that I don't particularly like even.

KATHERINE: Jay doesn't really have very much time to do anything any
more. He doesn't really read. He doesn't really get to go out too much. He
comes back, and because of the way the schedules work, his time is very
segmented and it's erratic.

JAY BONNAR: I remember going out shopping for rugs one day after I'd
just come back from call, and having very little tolerance for discussion. I
really didn't want to get into it too much.

KATHERINE: He's really...he's so exhausted. He's actually a pretty
hyper person, generally, by nature. And then to see him so worn out, just sort
of a shell. I mean, what I get is lousy. The best part of him goes away early
in the morning for the whole day, and then when he comes home what do I
have? He's this tired, grouchy thing. And he goes straight into bed and he
sleeps. And that's where we are.

JAY BONNAR: I came in four hours ago. So far I have admitted one
patient with fever, probable sepsis; done a lumbar puncture; subsequently
disimpacted that patient, which is great fun. What that means is to take all
the stool out of that person's rectum by hand. I have visited all of my own
patients in the hospital. Wrote notes on several of them. Checked their labs.
Drawn some blood tests on patients that needed them to be done. I've just now
wheeled up my second admission for the night and will be going shortly to
examine her. I'm taking a short food break because I'm getting a little
hypoglycemic here.

LUANDA GRAZETTE: I'll be a lot happier tomorrow, I think,about being a doctor, than I am today. I still have my last call night
ahead of me and I'm still kind of grumpy about that.

Do you do your own cooking?

PATIENT: Mostly sandwiches.

LUANDA GRAZETTE: Sandwiches are good.

PATIENT: No pots and pans to wash.

LUANDA GRAZETTE: And are you allergic to anything?

PATIENT: I'm allergic to tape.

LUANDA GRAZETTE: Adhesive tape? I wrote that down. We won't put any
adhesive tape on you. We'll put you on a strict no-adhesive tape diet. I want
you to follow my finger with your eyes.

I don't have any regrets about coming down this path. There are lots
of rewards. This is one of the professions where you actually can see that you
have a direct and hopefully beneficial effect on somebody's life, and that's a
wonderful thing.

PATIENT: You're not going to put me in restraints?

LUANDA GRAZETTE: We're not trying to kick you out.

PATIENT: But you're not going to put me in restraints? That's all I want
to know.

LUANDA GRAZETTE: If you can't follow the rules, then you'll have to be
restrained.

I think I have gotten a lot tougher. I was sort of shy at the
beginning of this process. And you really can't afford to be. I don't
miss it at all. Actually, it's much more fun to be ferocious.

Mr. Battersby, our little 90-year-old demented man that came in yesterday with
COPD and a history of AF, and tracheal bronchitis and horrible lungs.

At this point, I'm a doctor. I'm Dr. Grazette. That is who I am in this
hospital and in my clinic, Dr. Grazette. I'm not the Dr. Grazette thatI'll be in ten years. Hopefully I'll have learned a lot more, I'll have
grown a lot more, and I'll be a better Dr. Grazette. But I'm Dr. Grazette
now.

ELLIOTT BENNETT-GUERRERO: We're going to come and get you and bring you
on a stretcher.

Mr. Rogers is a 74-year-old gentleman who is going to be
having bypass surgery on his heart tomorrow.

Go ahead and put a breathing tube down. That goes...

It's very delicate discussing the risks of procedures and anesthesia
with patients. Because on the one hand you want there to be a full disclosure
and informed consent, and you want them to know what they're getting themselves
into, knowing the risks. On the other hand you don't want to take someone and
make them very, very anxious. If they have a bad heart, anxiety is very
bad.

It's nice meeting you, sir.

MR. ROGERS: Nice meeting you.

ELLIOTT BENNETT-GUERRERO: We'll take real good care of you.

MR. ROGERS: I know you will. I'll put my dependence in you.

ELLIOTT BENNETT-GUERRERO: Mr. Rogers, I'll take you into the operating
room now, okay? All ready to go?

After doing anesthesia for a year and a half, I think I take for
granted now, because I've done it so often, just how incredible it is
when you give somebody a general anesthetic.

I think Melissa was very unhappy with the amount of time that I spent at
the hospital. And the fact that I'd come home from work and I'd be
emotionally exhausted, especially after, say, a 36-hour shift.

MELISSA: It's hard to spend the time you need to work on a marriage
when you have a husband who's working 100, 120 hours a week. And whenever he's
at home, either his mind is at work or he's so emotionally drained from work
that he has no energy left for you or the relationship.

ELLIOTT BENNETT-GUERRERO: The fire was a really terrible thing. I
think one of the things that really disappointed me was that instead of it
bringing us closer together, I think it drove Melissa and I further apart.
Because we got separated about two weeks after the fire.

MELISSA: There wasn't really anything to keep us together. Because
our home was burned. We had nothing. Nothing was left after that fire, and it
was sort of easy for us to pick up and go and establish our ownnew lives independent of each other after that fire.

ELLIOTT BENNETT-GUERRERO: If you're a very, very needy person and you
always need a lot of attention and support from your spouse, you're probably
not going to be happy being married to a doctor.

MELISSA: I guess we've been separated for close to a year and a half
now, and it still makes me very sad when I think about it. Not that I don't
think it was for the best, but it still makes me sad. I think it always
will.

PRODUCER: And it all started with your toe?

MELISSA: It all started a tragedy and it ended a tragedy.

ELLIOTT BENNETT-GUERRERO: How much of this stuff do you have to put on?
Number four step.We don't want Tina to burn.

I'd say this is a very happy time in my life. Personally, I thinkthings are going well. Professionally, things are going great. I really
like what I'm doing. I like medicine. Anesthesiology is a lot of fun. I hope
medicine is this much fun for the rest of my life.

JAY BONNAR: Being a psychiatrist is a wonderful career. And I
appreciate having the medical background as well because it helps me understand
not only the mind but also the brain.

So here we are. Here's my office. Let's see, what have we got? We've got
the chairs for psychotherapy face to face, and the sofa for psychoanalysis.
This is where I see my patients. Oh, a wall full of diplomas, yes. That has
some impact as well. I don't spend much time with the diplomas these days,
though it represented a lot of work certainly.

I've decided to become a psychoanalyst, and that means that,amongst
other things, I participate in psychoanalysis myself. So for the past three
years I've driven across town to see my analyst four times a week, and I'll
probably be doing that for another few years.

Psychoanalysis is a treatment that is based on free association, which
means that the person in treatment is given the task of saying everything that
comes to mind. And that isn't something we ordinarily do in public or evenprivate life for the most part. If we were to say everything that came to
mind we'd be arrested or put in the hospital.

Psychoanalysis is fundamentally a private thing and has to be. Because when
you start talking about what's on your mind, it's the whole range of human
emotion including love, disappointment, anger, sex, lust. It's all in there.

Like most people in analysis, I'm hoping that what I get out of it is that
I'll be happier. I hope for relationships that are more stable. I hope for
greater satisfaction in my work and with myself as a person. Had this been an
actual analytic session I would have continued to lay here and talk about
whatever came to mind. And the analyst would have been sitting, much as I do
when I'm doing the treatments here, in this role. Listening, largely, taking
notes, thinking about it, reflecting on those thoughts.

I think that for many people including myself psychoanalysis is a lot about
getting to be kinder to yourself, to help people lighten up a bit on
themselves. And what people find is that they also then are more generous to
the people around them, which is nice, too.

Having been married and then having the experience of that falling apart,
and getting divorced, has been enormously impacting on who I am and how I feel
about myself and about other people, about stability, connectedness.

So here we are in my apartment. And this is a painting by Aiyae, who had a
show at the Boston Psychoanalytic Institute, which is where I saw it first and
fell in love with it and subsequently with the painter. Do you catch the ants?
Come here.

AIYAE: When I first met him, it was at the opening, but we only spoke
for about one minute. It was really crowded, and I was already—after
opening...post-opening fatigue. So we sort of got to know each other
through communicating about this particular piece, because he was interested in
it. And it was very refreshing for me to hear insight from someone
outside...who's outside of the art world.

JAY BONNAR: This is as deep an exploration of the mind as my
work.

AIYAE: He's a psychiatrist. And his insight from his experience was
very inspirational for me, actually.

JAMES BONNAR: I think that's part of the thing about being in
analysis, and being a psychiatrist. You get incredibly self-conscious. How are
people going to see you professionally? And what are people going to think?
Most psychiatrists don't do movies. Don't go on television. It's a field where
you tend to be fairly self-conscious. Part of the work is understanding your
own stuff. It's very, very important to understand yourself when you're
interacting with other people so that you don't have your own stuff get
in the way of the other person's healing.

DEANNE BONNAR: I mean,I think self-reflective is a better
word than self-conscious about that. That's what I hear you doing, too, is
reflecting on what are your motivations for getting into this.

JAY BONNAR: I mean, you're also talking to me at a time when I'm in
the middle of an analysis. One is very much focused on the internal. A lot of
focus goes too, to the things that have not worked well in life. And so, it's
real easy to portray yourself as being fairly pathological, which is
another concern of mine, too. And another reason for not particularly wanting
to do this filming right now.

ELLIOTT BENNETT-GUERRERO: So what we're going to do is we're going tobring you into the operating room and put an IV in. Then I'll start giving
you some medicine to make you pretty relaxed. Then, we'll put you off to sleep.
Give you some oxygen to breathe through a mask. Then we'll give you some
medicines in through your IV. How are you feeling? Okay? Nice big
breath.

Mr. Grant is 40 years old and unfortunately at a pretty young age,
he's got pretty bad heart disease. He's got blockages of a lot of the arteries
that feed the heart and it's these blockages that can lead to a heart attack if
they're not treated.

When I did this I really didn't feel much. When you first start out people
are feeling a lot, but basically when you become very experienced doing this,
you just kind of have a sense for where it is. My temperament is well-suited
for anesthesiology. I'm really very compulsive. I'm a real worrier. I hate it,
I really hate it if I'm working with a trainee and I don't get the sense
that they're really anxious, that they're really on edge waiting
for something bad to happen, because that's really,I think, part of
doing a good job.

DR. MEHMET OZ: I'm giving you some heavy silk.

The first time I met Elliott is when I was asked to interview him.
And he was considering coming over as an extraordinarily young chairman of the
division of cardiac anesthesia, which is for many of us the most powerful
position on the anesthesia side of the fence. And we went to the faculty club
together, and I was immediately impressed by Elliott. But I was even more
impressed when I told him about this wonderful study I had just seen in one of
the biggest journals that we have in this country, and I said, "I just wish we
could reproduce that." And he said, "Well, I wrote that paper."

ELLIOTT BENNETT-GUERRERO: Instead of putting the person on a
heart-lung machine, you actually put a little device to kind of hold the heart
a little bit still. And the surgeon actually sews these blood vessels onto the
heart while it's beating.

DR. MEHMET OZ: There's a dance that occurs and that has to be a
well-choreographed affair. And if you have a team that works well—and you have
to build that team, it doesn't come naturally, it really is a marriage—then
you have a whole that is greater than the sum of the parts.

ELLIOTT BENNETT-GUERRERO: And when it's working well, there's
silence. I know what he's doing. I'm taking care of what I need to get done. We
don't need to...it's like with dancing. You don't need to say, "Go left, go
right, one two three." You just know what to do.

KAREN: I think that I felt very comfortable marrying a doctor
because my father is a doctor and I grew up with a lot of doctors in my
family.

Oh, look at the geese.

ELLIOTT BENNETT-GUERRERO: Look at the little pretty ducks.

KAREN: Aren't those geese?

ELLIOTT BENNETT-GUERRERO: I guess so. I don't know. Ducks, geese, what's
the difference? I'm not Mr. Nature Boy. Are any of these ripe?

KAREN: They all look ripe.

ELLIOTT BENNETT-GUERRERO: One thing that works in our relationship is
that we both have high standards for what we do, even though we have different
kinds of professions. And so I think that Karen can appreciate and
respect the fact that I'm really so dedicated to my profession. And I also...I
respect the fact that Karen really takes the work that she does very
seriously.

I remember when I was a kid you could buy a whole watermelon like this for a
dollar. And now it's 50 cents a pound.

KAREN: That's what you keep telling me. I don't think this was ever a
dollar.

ELLIOTT BENNETT-GUERRERO: It was in upstate New York when I was a kid.
When I was 10 years old you could buy a whole one for a dollar. And now things
are getting so expensive.

And I think also we're basically both very good-hearted, traditional people
who basically want to have a stable, happy family life.

LUANDA GRAZETTE: She wants you to know everything that's going on
because you guys are a team.

I thought I was going to do general cardiology, and as it turns out
I ended up in probably the most sub-specialized area imaginable, in
transplant.

This patient is a middle-aged woman who has had a diagnosis of
cardiomyopathy. Our task is to try to figure out why all of a sudden her heart
failure is so much worse.

Oh, there it is. That's it. You don't get much better than that. We're going
to need to look at the echo in a little bit more detail and see whether or not
there's some options, short of transplantation, that might be helpful for you.

So her numbers are actually not particularly bad. CVP is still in the
teens.

I'm still excited about medicine. I think it's very difficult not to be
excited because it's constantly changing.

Consider her for a mitral replacement and anular plasty.

I've been around long enough to be able to say, "Well I've seen
things evolve, and diseases that there weren't good approaches for when I
started medical school, there are now rational therapies for."

Hello there. You're sort of dressed as if you're ready to leave here. I don't
think there's anything we could tell you that would make you stay.

One of the things that is attractive about transplant medicine is that it
is a very intimate relationship between the cardiologist and the patient.

PATIENT: You've been wonderful. You did a good job, both of you.

LUANDA GRAZETTE: That's actually a joy. That's one of the great parts
of the job, is that you do get to have this ongoing very rich and deep
relationship with the patients.

PATIENT: I know you stopped me from going home, but it was worth
it.

LUANDA GRAZETTE: It was necessary.

PATIENT: I know, I understand.

LUANDA GRAZETTE: All right. Good to see you.

PATIENT: Good to see you. I'll see you again. Bless you.

LUANDA GRAZETTE: This is still pretty time-intensive. And I think I
take the time that I do have with family and friends, or sort of doing things
that I enjoy, much less for granted than I did when I was in internship and
residency. I'm sort of at that stage in life where you start to...like you see
that point approaching where you have just as many years ahead of you as you
have behind you. And I think that that makes you stop and reflect and think
about. "Am I doing things that I really enjoy and that I find fulfilling?" I
think that this is a field to go into because you can't imagine not doing it.
It was definitely worth it for me.

NOVA producer Michael Barnes has chronicled the lives of these doctors for
14 years. How did he choose them? What challenges did he face along the way? Go
behind the scenes on NOVA's Web site at PBS.org or American Online, Keyword PBS.

To order the three-hour Survivor M.D. special, for $29.95 plus
shipping and handling, please call WGBH Boston Video at
1-800-255-9424.

Next time on NOVA: the race to unravel a three-billion-letter mystery.
"This is the ultimate imaginable thing that one could do scientifically, is
to go and look at our own instruction book and then try to figure out what it's
telling us." Cracking the Code of Life.

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